Cognitive Assessments for Elderly

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The following is an overview of 3 screening tools for cognition in older adults.The purpose, procedure, and results data for each will be detailed. The purpose of this Wiki is to become familiar with 3 cognitive assessments for the older adult, and provide instructions to utilize them correctly with patients.

Objectives

1. Understand the screening process and testing basics.
2. Select proper assessment tool to use with particular individuals (age, ethnicity, education level, etc.)
3. Differentiate scoring differences for normal aging adults compared to those with dementia.
4. Determine the benefits and limitations of each cognition screening exam.

SLUMS-Saint Louis University Mental Status Exam

Overview

  • Originally developed to detect early dementia symptoms or mild cognitive impairment (MCI) (11)
  • Developed as an alternative screen to the Mini Mental Status Exam (MMSE) (7,10)

Testing Basics

  1. 11 Item Test
    1. Includes: cognition, orientation, short term memory, clock drawing, etc. (4)
  2. Scoring
    1. Ranges from 0-30 (4,10)
      1. Scores vary based on level of education
        1. High School Education
          1. Normal: 27-30
          2. Mild neurocognitive disorder: 21-26
          3. Dementia: 1-20
        2. Below High School Education
          1. Normal: 25-30
          2. Mild neurocognitive disorder: 20-24
          3. Dementia: 1-19

Advantages

  • More sensitive than MMSE in detecting MCI and early signs of dementia. (6)
  • Free use of test and scoring sheets.
  • Quick- typical testing only takes 7-10 minutes.
  • Available in several languages. (10)

Disadvantages

  • Not as widely known or used as other cognitive tests.
  • Research beyond a few initial studies has not been conducted.
  • Possible future issue with "clock drawing" due to use of digital clock faces. (10)

Link to SLUMS

Mini Mental Status Exam

Overview

  • Published in 1975 to grade cognitive impairments.
  • A new version is currently under development.(3)

Testing Basics

  1. 19 individual tests covering 11 domains (5)
    1. Includes: orientation, recall, naming, writing, etc.
  2. Scoring (3)
    1. Ranges of 0-30
    2. Interprets in different domains
      1. Ranges
        1. Decreased odds of dementia: >25
        2. Abornal: <24
        3. Increased odds of dementia: <21
      2. Education
        1. Abnormal for college education: <24
        2. Abnormal for high school education: <23
        3. Abnormal for 8th grade education: <21
      3. Severity
        1. No cognitive impiarment: 24-30
        2. Mild cognitive impairment: 18-23
        3. Severe cognitive impairment: 0-17
    3. Implications of severity scores (3)
      1. 25-30 (questionable significant)
        1. Clinically significant but mild deficits. Likely only affects most demanding tasks of ADLs.
      2. 20-25 (Mild)
        1. Significant effects. May require supervision, support, or assistance.
      3. 10-20 (Moderate)
        1. Clear impairment. May require 24 hour supervision.
      4. 0-10 (Severe)
        1. Marked impairment. Likely to require 24 hour supervision and assistance with ADLs.

Advantages

  • Widely used and validated screening tool.
  • Sensitivity and specificity of test are reasonably good.
  • Allows for re-evaluation and following changes over time.
  • Available in several languages and adaptations for verbally-impaired patients. (9)

Disadvantages

  • Adjustments needed to be made for age, education, and sometimes ethnicity.
  • Copyright issues with previously free version.
  • Now must be officially ordered through Psychological Assessment Resources. (9)

Link to MMSE

Mini Cog

Overview

  • Quick exam for cognitive impairment
  • Used for early recognition of cognitive deficits (1)

Testing Basics

  1. 2 item test (2)
    1. Includes: 3 item recall and clock drawing test
  2. Scoring (1)
    1. Ranges from 0-30
      1. Item Recall
        1. 1 point for every item recalled.
      2. Clock Drawing Test (CDT)
        1. Normal or Abnormal
    2. Overall Scores (8)
      1. 0 (recall) : Demented
      2. 1-2 (recall) and Normal CDT : negative for cognitive impairment
      3. 1-2 (recall) and Abnormal CDT: positive for cognitive impairment
      4. 3 (recall) : Negative for dementia (No CDT score needed)

Advantages

  • Not influenced by education level, ethnicity, or language abilities.
  • Fast and free.
  • Sensitivity and specificity are excellent.(8)

Disadvantages

  • Interpretation of clock drawing test can cause vulnerability.
  • Possible future issue with "clock drawing" due to use of digital clock faces.
  • Administrators giving instruction AFTER test has been initiated. (8)

Link to Mini-Cog



References

1.
Borson, S., et al. The Mini-Cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. International journal of geriatric psychiatry. 2000;15:1021-1027.
http://www.cpnstudy.org/wp-content/uploads/2010/05/Mini-Cog.pdf

2.
Borson, S., et al. The Mini‐Cog as a screen for dementia: validation in a population‐based sample. Journal of the American Geriatrics Society. 2003;51:1451-1454.
http://deepblue.lib.umich.edu/bitstream/handle/2027.42/65703/j.1532-5415.2003.51465.x.pdf?sequence=1&isAllowed=y

3.
Brodaty, H., et al.(2006). What is the best dementia screening instrument for general practitioners to use?. The American journal of geriatric psychiatry. 2006;14:391-400.
http://gpcog.com.au/files/Brodaty%20et%20al%20What%20is%20the%20best%20dementia%20screening%20instrument.pdf

4.
Cruz-Oliver DM., et al. The Veterans Affairs Saint Louis University mental status exam (SLUMS exam) and the Mini-mental status exam as predictors of mortality and institutionalization. The journal of nutrition, health & aging. 2012;16: 656-641.
http://link.springer.com/article/10.1007/s12603-012-0098-9#page-1

5.
Mitchell, AJ. A meta-analysis of the accuracy of the mini-mental state examination in the detection of dementia and mild cognitive impairment. Journal of psychiatric research, 2009;43:411-431.
http://www.journalofpsychiatricresearch.com/article/S0022-3956(08)00112-X/abstract?cc=y=

6.
Petersen, RC. Mild cognitive impairment. New England Journal of Medicine. 2011;364: 2227-2234.
http://enotes.tripod.com/mild_cognitive_impairment2011.pdf

7.
Petersen, R.C., et al. Practice parameter: Early detection of dementia: Mild cognitive impairment (an evidence-based review) Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2001;56:1133-1142.
http://www.ciape.org.br/matdidatico/anacristina/diagnostico_de_demencias_2001.pdf

Resources

8. http://alzheimers.about.com/od/testsandprocedures/a/The-Mini-Cog-And-Its-Use-As-An-Alzheimers-Screening-Test.htm

9.http://alzheimers.about.com/od/testsandprocedures/a/The-Mini-Mental-State-Exam-And-Its-Use-As-An-Alzheimers-Screening-Test.htm

10. http://alzheimers.about.com/od/testsandprocedures/a/Saint_Louis_University_Mental_Status_Examination.htm

11. http://psychcentral.com/news/archives/2006-11/slu-nds103006.html